Perfectionism and therapeutic alliance: a review of the clinical research

In this review, we synthesize findings regarding the relationship between perfectionism and therapeutic alliance, most of which come from analyses by Blatt and colleagues. Results suggest what follows. First, patients’ initial level of perfectionism negatively affects patients’ bond with therapists and perception of therapists’ Rogerian attributes (empathy, congruence, and regard) early in treatment and engagement in therapy later in treatment. Second, therapists’ contribution to alliance is not seemingly affected by patients’ initial perfectionism level. Third, individual patients of therapists who are perceived on average by their patients to be higher on Rogerian attributes experience greater decreases in perfectionism and symptoms. Fourth, more positive perceptions of therapists’ Rogerian attributes early in treatment lead to greater symptom decrease for patients with moderate perfectionism. Fifth, greater early patient engagement in therapy is related to greater decrease in perfectionism, but a strong relationship with the therapist may be necessary for an accompanied greater decrease in symptoms. The relationship between pre-treatment perfectionism and alliance is partially explained by higher levels of hostility and lower levels of positive affect. Sixth, the relationship between pre-treatment perfectionism and outcome is almost entirely explained by level of patient contribution to alliance and satisfaction with social network, highlighting the importance of focusing on social functioning for patients with high perfectionism (both in and outside of the session). Limitations include that most of the findings are from analyses of one large data set and a range of measurement issues. Future research should utilize different measures, perspectives, and populations and examine specific session process

PMN J1632-0033: A new gravitationally lensed quasar

We report the discovery of a gravitationally lensed quasar resulting from our survey for lenses in the southern sky. Radio images of PMN J1632-0033 with the VLA and ATCA exhibit two compact, flat-spectrum components with separation 1.47" and flux density ratio 13.2. Images with the HST reveal the optical counterparts to the radio components and also the lens galaxy. An optical spectrum of the bright component, obtained with the first Magellan telescope, reveals quasar emission lines at redshift 3.42. Deeper radio images with MERLIN and the VLBA reveal a faint third radio component located near the center of the lens galaxy, which is either a third image of the background quasar or faint emission from the lens galaxy.Comment: 21 pp., including 4 figures; thoroughly revised in light of new MERLIN/HST data; accepted for publication in A

PMN J1838-3427: A new gravitationally lensed quasar

We report the discovery of a new double-image quasar that was found during a search for gravitational lenses in the southern sky. Radio source PMN J1838-3427 is composed of two flat-spectrum components with separation 1", flux density ratio 14:1 and matching spectral indices, in VLA and VLBA images. Ground-based BRI images show the optical counterpart (total I=18.6) is also double with the same separation and position angle as the radio components. An HST/WFPC2 image reveals the lens galaxy. The optical flux ratio (27:1) is higher than the radio value probably due to differential extinction of the components by the lens galaxy. An optical spectrum of the bright component contains quasar emission lines at z=2.78 and several absorption features, including prominent Ly-alpha absorption. The lens galaxy redshift could not be measured but is estimated to be z=0.36 +/- 0.08. The image configuration is consistent with the simplest plausible models for the lens potential. The flat radio spectrum and observed variability of PMN J1838-3427 suggest the time delay between flux variations of the components is measurable, and could thus provide an independent measurement of H_0.Comment: 23 pages, incl. 6 figures, to appear in A.J.; replaced with accepted version; minor changes to text, improved figure

A nearly symmetric double-image gravitational lens

We report the discovery of a new double-image gravitational lens resulting from our search for lenses in the southern sky. Radio source PMN J2004-1349 is composed of two compact components separated by 1.13 arcseconds in VLA, MERLIN and VLBA images. The components have a flux ratio of 1:1 at radio frequencies ranging from 5 GHz to 22 GHz. The I-band optical counterpart is also an equal double, with roughly the same separation and position angle as the radio double. Upon subtraction of the components from the I-band image, we identify a dim pattern of residuals as the lens galaxy. While the present observations are sufficient to establish that J2004-1349 is a gravitational lens, additional information will be necessary (such as the redshifts of the galaxy and quasar, and precise astrometry and photometry of the lens galaxy) before constructing detailed mass models.Comment: 17 pp., 5 bitmapped figs. (contact [email protected] for nicer figs), in press, A.J. (substantially revised

Perfectionism and psychological distress: A modeling approach to understanding their therapeutic relationship

The present study assessed the effectiveness of a web-based psychoeducational intervention protocol for decreasing levels of perfectionism and psychological distress. Different levels of therapeutic intervention (no treatment, general stress management intervention, general stress management intervention plus cognitive behavioral intervention) were provided to perfectionistic participants over a 10-week period. It was found via a longitudinal structural equation model that higher levels of therapeutic intervention predicted greater improvements in perfectionism and psychological distress. Further, amount of improvement in trait perfectionism and perfectionistic automatic thoughts was highly related to amount of improvement in psychological distress. The findings attest to the potential usefulness of a web-based intervention that combines a general stress management intervention with a cognitive behavioral intervention.Social Sciences and Humanities Research Council (SSHRC

Prognostic value of lymphocyte vascular density and e-cadherin in inflammatory breast cancer

Background: We recently evaluated four laboratory assays, vascular endothelial growth factor D (VEGF-D), E-cadherin, lymphatic vessel density (LVD) measured by podoplanin, and intra-lymphatic tumor emboli (ILTE), which showed notable differences between inflammatory breast cancer (IBC) and non-inflammatory locally advanced breast cancer (LABC). In this study we investigated the potential of the three most quantitatively measured markers, E-cadherin, LVD and VEGF-D, to predict survival in the IBC patients. Materials and Methods: This study involved the 100 cases identified in the Inflammatory Breast Cancer Registry (IBCR) whose tumors were previously evaluated for the four assays noted above. Living patients were recontacted and survival data were available for up to 17 years. Overall survival (OS) was analyzed through the Kaplan-Meier method stratified by E-cadherin, LVD, VEGF-D, and response to chemotherapy. The differences in OS curves were compared using the log-rank test. Results: The median OS for patients with high LVD was 6.63 years (95% CI: 4.06 to 10.14), compared to median at 10 years not reached in those with low LVD (p = 0.03). There was a trend towards a longer median OS in patients with high E-cadherin (10.14, 95% CI: 6.63 to 11.67), compared with those with low E-cadherin (6.26, 95% CI: 3.42 to undeterminable). VEGF-D levels showed no correlation with survival. Conclusion: Low LVD significantly predicts better survival. High E-cadherin expression, as with non-IBC breast cancer and several other malignancies, tends to be associated with a better prognosis

Dynamic changes in perfectionism dimensions and psychological distress among adolescents assessed before and during the COVID-19 pandemic

This prospective longitudinal study evaluated changes in psychological distress among adolescents, pre-pandemic to intra-pandemic, the extent to which within-person and between person differences in trait multidimensional perfectionism were associated with such changes, and the role of stress in explaining associations between perfectionism and psychological distress. Adolescents (N = 187; 80% female; 78% White, 7% Asian Canadian, 2% Indigenous Peoples in Canada, 2% Black or African Canadian, 2% Latin Canadian, or 9% Other; Mage = 17.96 years) completed online surveys assessing perfectionism (i.e., self-oriented [SOP] and socially prescribed perfectionism [SPP]), depression, anxiety, and stress pre-pandemic (i.e., March 12th, 2020 or earlier) and during Ontario, Canada’s first (i.e., March 13th, 2020 to July 24th, 2020) and second (December 26th, 2020 to February 7th, 2021) government-mandated lockdowns. Between-person differences and within-person changes in multidimensional trait perfectionism were associated with increases in psychological distress and perceived stress. Perceived stress served as an intermediary pathway linking multidimensional trait perfectionism to psychological distress during the pandemic